Neurointensivismo na Copa FIFA 2014: Concussão Cerebral, quando devemos liberar o jogador para retornar ao jogo?

Neurointensivismo na Copa FIFA 2014: Concussão Cerebral, quando devemos liberar o jogador para retornar ao jogo?

Concussão cerebral é uma síndrome neurológica pós trauma de crânio caracterizada pela alteração da função neurológica, em especial,  memória e  orientação e que também pode esta associada a perda de consciência. 

Após concussão cerebral dia 18.06.14 em jogo contra a Austrália, o zagueiro Bruno Martins Indi foi liberado pelo departamento médico e retornou 24.06.14 aos treinos da seleção holandesa, que se prepara para jogar contra o México nas oitavas de final da Copa do Mundo de Futebol 2014 no Brasil.

Este fato foi bastante questionado pela imprensa brasileira. Afinal, quanto tempo este jogador precisaria para recuperar-se e quais os riscos envolvidos?

Devido a perda da consciência, a concussão sofrida pelo jogador Martins Indi foi classificada pela American Academy of Neurology como Grau 3 e portanto deveria ficar afastado dos jogos por  2 semanas pois sua perda de consciência foi prolongada (minutos). 

Summary of Recommendations for Management of Concussion in Sports

     A concussion is defined as head-trauma-induced alteration in
mental status that may or may not involve loss of consciousness.
Concussions are graded in three categories. Definitions and
treatment recommendations for each category are presented below.

Grade 1 Concussion
--  Definition: Transient confusion, no loss of consciousness, and
    a duration of mental status abnormalities of less than 15
    minutes.

--  Management: The athlete should be removed from sports
    activity, examined immediately and at 5-minute intervals, and
    allowed to return that day to the sports activity only if
    postconcussive symptoms resolve within 15 minutes. Any athlete
    who incurs a second Grade 1 concussion on the same day should be
    removed from sports activity until asymptomatic for 1 week.

Grade 2 Concussion
--  Definition: Transient confusion, no loss of consciousness, and
    a duration of mental status abnormalities of greater than or
    equal to 15 minutes.

--  Management: The athlete should be removed from sports activity
    and examined frequently to assess the evolution of symptoms, with
    more extensive diagnostic evaluation if the symptoms worsen or
    persist for greater than 1 week. The athlete should return to
    sports activity only after asymptompatic for 1 full week. Any
    athlete who incurs a Grade 2 concussion subsequent to a Grade 1
    concussion on the same day should be removed from sports activity
    until asymptomatic for 2 weeks.

Grade 3 Concussion
--  Definition: Loss of consciousness, either brief (seconds) or
    prolonged (minutes or longer).
--  Management: The athlete should be removed from sports activity
    for 1 full week without symptoms if the loss of consciousness is
    brief or 2 full weeks without symptoms if the loss of
    consciousness is prolonged. If still unconscious or if abnormal
    neurologic signs are present at the time of initial evaluation,
    the athlete should be transported by ambulance to the nearest
    hospital emergency department. An athlete who suffers a second
    Grade 3 concussion should be removed from sports activity until
    asymptomatic for 1 month. Any athlete with an abnormality on
    computed tomography or magnetic resonance imaging brain scan
    consistent with brain swelling, contusion, or other intracranial
    pathology should be removed from sports activities for the season
    and discouraged from future return to participation in contact
    sports.

Source: Quality Standards Subcommittee, American Academy of
Neurology.

Os riscos envolvidos no retorno precoce estão numa síndrome neurológica conhecida como Síndrome do Segundo Impacto, uma condição rara onde ocorre um inchaço cerebral rápido após um segundo trauma de crânio leve podendo ocasionar o óbito.

Como Neurointensivistas devemos previnir a lesão secundária. Portanto, seguir as recomendações médicas são de fundamental importância.

Referências:

1. Summary of evidence-based guideline update: evaluation and management of concussion in sports: report of the Guideline Development Subcommittee of the American Academy of Neurology. PUBMED